Respiratory Therapy 101: Just Keep Breathing

I was on a website for song lyrics earlier this evening attempting to decipher the wailings of a vocalist whose tunes I enjoy listening to when I noticed an ad at the top of the webpage.

For Proventil HFA.

This is why I spent my day doing Q4 treatments on people who have absolutely no indication for their treatment: subtle, effective advertising. It’s a tool of the conspiracy….very, very sneaky.

I was relegated to the floors today. At first I was afraid that it was punitive, but then I was informed that it was a simple error and that my float had been recorded again so that with any luck I won’t have to go back to the floors soon.

It’s not floor therapy itself that bothers me, although it certainly is a lot less exciting than ICU therapy. It’s the fact that, during the day at this particular place with our particular policies, it is impossible to stay organized.  We have a one-million square foot physical plant at Sunny Flats. We also have a history of dividing the assignments so that a floor therapist has patients on square feet one and nine-hundred ninety-nine thousand nine-hundred ninety-nine. Miles and miles of walking.
I try to keep on top of things, but between having dozens of patients in varying schedules and trying to wrest the charts from doctors and nurses, it’s very difficult to stay on top of things. Add to that the fact that one nebulizer must be charted in four separate places, and it’s impossible to keep on top of everything. The end result is just that at the end of the day, I feel frustrated and like I’ve done a terrible job at everything. C’est la vie.

Maybe tomorrow will be better.

Tonight was the Sunny Flats Respiratory Care Services Christmas Bash. Those of us who weren’t working nights or feeling antisocial went and gathered at the clubhouse of a local country club to eat, drink and be merry.

The party began at seven and was slated to continue until eleven. I knew I wouldn’t be able to make it at seven since I was working today, but I was hoping to make it in for 9:30 or so. But one thing led to another, and there were things to take care of, and by the time I got to the party it was 10:00.

I screeched into the parking lot at the country club and strode up to the door. I heard thumping sounds from behind the door, and with a deep breath and hoping that I wouldn’t accidentally wind up barging into a wedding reception or something I flung open the doors and strode in exactly as a zesty Latin song began to play on the stereo. There was a pause as I examined the room: unfamiliar faces in the shadows stared back at me as I looked in on this party I had busted.

And suddenly, a tall man stood up and called my name. The room burst into applause and I laughed as I recognized the manager of respiratory care. I threw my arms up in a Y shape and laughed maniacally in my confusion: why were they applauding me? I’m likable and all but I’m just me.

Suddenly, without warning, The Director of respiratory care appeared from the shadows. She flipped a grin at me and laughed:

“You know, this means that now you have to DANCE!” I was grabbed and flung into the unfamiliar steps of a Latin dance groove. I don’t really know how to describe myself, but I think that a couple of good words would be “tall” and “awkward.” “Clumsy” occasionally comes to mind as I have poor peripheral vision and occasionally run into things like door frames or low-lying shelves. Watching me try to dance…is indescribably awkward. Especially compared to the relatively decent dancing of The Director, I probably looked like a store mannequin having a seizure (people who know me: you know this is true.) But people seemed to like it, and after a few minutes of having no idea how to dance The Director took pity on me and led me to the food.

So: for showing up three hours late, I certainly managed to make a spectacular entrance. This might be my best one yet. I must say I really did enjoy myself.

Here’s a fascinating tidbit: Penguins can return to the surface after long dives with “blood oxygen levels,” presumably the Penguin equivalent of their PaO2, that are approaching zero. Evidently their hemoglobin is structured differently form ours in some insane way that makes it more efficient, so that penguins can dive to untold depths for up to 26 minutes and survive. To put that in perspective, if I held your breath for 26 minutes you would be what we in the medical world call “dead.”

So, what can we learn from this? Maybe someday we can develop a new medication based on penguin hemoglobin that will improve survivability in patients with severe diffusion defects or ARDS-style syndromes.

Fascinating.

This is a subject I’ve not yet covered. I’m sure there are those among you who are wondering, “how did this weirdo get into respiratory therapy in the first place?” I aim to answer your question today. I decided to do this when discussing my entry to the land of RT with my charge therapist this afternoon.

Many people have inspiring stories about how they got into RT. For example: I know a lot of RTs who are asthmatics. Their childhood experiences led them down a path wherein they are trying to help other people to breathe. I know several people who were in another line of work, say accounting, when they suddenly had to help care for a family member with a respiratory illness. And there are plenty of people who will tell you that they got into respiratory therapy out of an altruistic desire to help other people breathe.

Not so much with me. I’ve never really been an altruist, and while I am asthmatic my experiences in the hospital never particularly made me want to spend my working life there.  No, I became an RT in a way that nobody else I’ve met has.

Before I went to RT school I had always wanted to be a pilot. From the earliest days of my childhood, I remember looking into the skies and watching my father hotdogging a C-150 overhead. I remember being thrilled with the noise of a prop plane, totally hypnotized by the motions of aircraft on the tarmac. I remember spreading old aviation maps around on my bed and dreaming of places to go. I was totally in love with the notion of being able to climb into the cockpit every single day and just fly.

Then 9/11 happened, and my dreams collapsed in a pile of ash with the souls of 3000 innocent people. The bottom fell out of the job market for pilots and I found myself wandering around in a daze with no direction, no aim in my life. I had no idea what to do with myself and I seriously considered just going to college and getting a philosophy degree, the back of which I could use to scribble the legend WILL WORK OR TELL YOU WHY YOU ARE WRONG FOR FOOD on.

One day I was walking down a hallway pondering my existence. I was seriously wondering what to do with my life: enlist in the Coast Guard? Go get a worthless degree? Flip some burgers and slack off for ten years, sinking deeper and deeper into the depression of underachievement? While in the middle of my ponderings something caught my eye. I turned and looked, and saw a flyer taped to the wall. The flyer said, in large friendly letters:

Make a difference! Be a RESPIRATORY THERAPIST!

And I thought to myself: Ah, providence! Ask for an answer and it will be given to you. It was a week to the day later that I applied to the RT program at North Woods Technical College, and about a year later I found myself in a classroom learning about breathing, that fundamental yet easily forgotten function which undeniably has an enormous impact on our lives.

And here I am today, a few years later, sitting in a place I never thought I’d be doing things I never thought I’d do. It’s an interesting job…it’s not flying, but it’s not all bad either.  I think I’ll be sticking around for awhile.

This is part two in my series on the Rules of the House of God. I am continuing this series out of a combination of boredom and a fascination with the cynicism in Shem’s work.

Rule number two in The Rules states that Gomers Go to Ground.  “Go to Ground” is a nice way of saying that these confused old people have an alarming tendency to fall and damage themselves. If a cynical and somewhat misanthropic physician was sick of medically managing a gomer, the theory put forward in the book is that they could simply raise the bed to “ortho” or “neuro” height and simply wait for the inevitable, after which the gomer could be transferred from the medical service to ortho/neuro.  You understand that I’m not endorsing this particular course of action, I’m just relaying the message from the book to the internet.

Regardless of whether the encouragement of this phenomenon is ethical, the phenomenon of gomers going to ground exists. During my years of working the night shift, I helped nursing scrape dozens of gomers from the floor upon which they had fallen and gone “splat.” There are few things more saddening than seeing a once-proud human being reduced to a pile of carbon-based gravity bait, but it does tend to happen more and more as people age.

One of the most memorable brushes I’ve ever had with rule two involved a floridly psychotic detoxing old Frenchman in the ICU in the great north woods.  The Frenchman had been experimenting with recreational chemistry at his home in the middle of the woods when he took a spill and whacked his head. The combination of brain injury, withdrawal, mental illness and ICU delerium after a few days on the vent had made The Frenchman into an unbelievably crazy old man. He was being given enormous amounts of sedation but was still wide awake and combative.

One night I was walking past The Frenchman’s room when I heard a noise. A noise like a bed being raised. This piqued my curiosity and I went into his room to find that he was seated on the edge of his bed, ET tube barely held in with a wad of tape, vent tubing pulling over his rising bed. He was swinging his legs as he got higher and higher off the ground, and I managed to yell for help and push his torso back onto the bed with a violent shove to the chest before he fell five feet onto the ground and died. If I hadn’t have walked into his room at that moment, The Frenchman would have been sucked into the vortex of Rule Two and met a traumatic end on the tiled floor of the unit.

I’ve seen the elderly confused slip on their own Go-Lytely poo and faceplant into the tile. I’ve seen old folks fall and crack hips and femurs after a slip on the ice or after a bender. I’ve heard the unmistakable thud of a body hitting the floor followed by the profanity laced confustications of the confused at three AM. I have seen it hundreds of times: gomers always go to ground. I don’t know what it is or why they have this powerful urge to hit the floor, but the rule rarely fails. Gomers, if left unchecked, will always go to ground.

I’d continue but I’m tired and this post is almost 600 words already and I think I’ve made my point. Any good grounding stories from my readers?

Today was another exciting day in the CCU. Our screamer from yesterday, the lady who screamed for STANLEY and THE POTTY all day, was in rare form after a restful night on BiPAP. She began the morning with a lovely, rousing rendition of STANLEY! GET ME STANLEY! STAAAANLEEEEY! which was followed by a solid two-hour chorus of I NEED TO POOP. After this long and loud performance she needed a nap and thankfully conked out until midafternoon.

Sadly, she woke from her nap as energetic as ever. But somewhere in her rusting old brain, somewhere amidst the dementia and the confusion and the tragic fog of old age,  she knew that an afternoon nap needed to be followed with an afternoon pick-me-up. I was sitting at the computer terminal near her room when she began screaming again.

COFFEE! GIVE ME SOME GODDAMN COFFEE! I WANT COFFEE! I checked my watch and sighed. Only a couple of hours to go until shift change. Her nurse, a man with much more patience and understanding then I will ever have, poured her a cup of joe and brought it in to her. She chugged it down and then smacked her lips, burped, and resumed her screaming. I and a few nurses sang along with her, quietly so as not to let others see us mocking a patient: “Coffee! Don’t you want some coffee? Let’s have some coffee!” We yukked it up for a few minutes but suddenly the screaming stopped. The faint sounds of mumbling came through the closed door of The Screamer’s room.

We all listened intently.  A sharp silence fell over the CCU, like the stillness in the air before a thunderstorm.

The clouds broke.

STOP YELLING ABOUT THE GODDAMN COFFEE! STOP YELLING ABOUT THE GODDAMN COFFEE!

I laughed so hard I almost peed myself.

Forgive me for the relatively poor quality of this post. It has been a long and tiring few days; I was working in the ER Friday and did 32 blood gases, 35 treatments, a couple of BiPAPs and transports and general nonsense so I was beat. And today I had a lengthy and insane day in which everything happened at once right at the end of the day. On the bright side, I did intubate two people within ten minutes, bringing my total to five. Not many but it’s still exciting to me. Anyway, enjoy this post about The Screamers.

We have had a lot of screamers lately in the hospital. In addition to a lady who sounded exactly like a train, I’ve had a number of encounters with screamers lately–more so than usual. I’m not sure what is bringing them all in but it has made life interesting.

The first in this chain of screamers came when I was relegated to the floors. Floor care is not normally something I mind, but the way that floor care is stacked here in Sunny Flats one therapist typically winds up with something like thirty patients to see and they’re all spread out across our million-square-foot physical plant. “Floor care” here means “get out your walking shoes and bring a Sherpa along.”

Anyway, I had hiked all the way from our main RT office across the hospital campus to East Three. I ran several treatments, and oddly enough most of my patients had been fairly normal. This was odd; East Three has a Reputation. Soon enough I discovered why. I strode into a room and saw my patient, a 90-year old lady lying supine and staring at the ceiling. I checked my treatment list and saw the legend “HoH” next to her name. Knowing now that she was mostly deaf I took a deep breath and shouted.
“Hello, Mrs. Redacted! I’m here to give you some breathing medicine!” I reached out and softly tapped the patient’s shoulder. She began a Slow Roll, turning her steady unblinking gaze from the air in front of her face to my general direction. She opened her mouth and took in a slow, raspy breath–

“HEEELP MEEEE! H-E-L-L-E-L-P! HEEEEELP MEEEE!”

I winced. The volume of her voice was unexpected compared to the size of her body and the age of her lungs. She took another deep breath and screamed again.

“HEEELP MEEEE! H-E-L-L-E-L-P!” She continued screaming for the duration of her treatment and for some hours after. What intrigued me was her spelling; most patients don’t spell, but the manner of her misspelling seems odd to me.

:::

Today, in the CCU, I was assigned to an elderly patient who had self-extubated just before my arrival in the morning. She had self-extubated mainly to facilitate her desire to scream, which she did liberally.

“STANLEY! STANLEY! GET THIS NOSE OFF OF MY NOSE!” was her first chant, but soon enough she replaced it with “I CAN SEE MY BLADDER!”  and then “STANLEY! I WANT POTTY!”

Nobody knows who Stanley is.